Cost control still a key goal
Published 9:41 am Sunday, November 15, 2009
Perhaps we’re misreading recent statements from the White House about health-care reform. We hope so, because on the surface, they seem to suggest a willingness to compromise away serious moves to fundamentally change the broken economics of health care.
Covering millions of the uninsured with the help of federal subsidies remains a central tenet, as does removing pre-existing conditions as a barrier to health coverage.
But another key principle, significantly reducing the escalation in health-care costs that has ravaged the budgets of families, businesses and governments alike, seems to be languishing as the debate comes closer to its climax.
White House Chief of Staff Rahm Emanuel has recently been dismissive of those who say costs aren’t being addressed sufficiently, telling The New York Times that the goal is to get a bill through Congress, not figure out what a perfect plan would look like.
Meanwhile, President Obama has subtly rebranded the overall effort, which he now refers to as health insurance reform — a mere subset of the greater reform goals he laid out during his election campaign.
For health-care reform to make a sustainable, long-term difference, it must seriously address the flawed economics that have driven costs ever upward. The recently passed House bill only scratches the surface on that score. The Senate Finance Committee did a better job, leaving hope for a final bill that puts us on a path toward the fundamental cost changes that are needed.
Sen. Maria Cantwell (D-Wash.), a member of the Finance Committee, succeeded in getting some meaningful amendments into that panel’s bill. One would change the way Medicare pays physicians, establishing a value-based index that rewards doctors for providing high-quality, efficient and coordinated care. Because Medicare is so huge, changes in its payment structure are likely to spread throughout the entire health-care system.
This, along with a proposal to band doctors together in “accountable care organizations” that coordinate patient care (like the highly regarded Everett Clinic does now), are crucial steps away from the failed “fee-for-service” structure that pays providers for the amount of care they provide rather than its quality. Providers have a financial incentive to order more tests and procedures, whether or not they’ve been shown to be effective.
Other ideas for controlling costs should also be in the final bill, including taxing the richest employer-sponsored health plans, thereby prompting employers to seek better-run plans and giving employees a greater financial incentive to take better care of their own health.
Real reform is about more than changes in insurance, however. It’s about putting the entire system on a path toward higher quality and more cost-effective care for everyone. Those goals mustn’t be compromised.
